International Journal of Nursing Sciences 4 (2017) 5e7
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International Journal of Nursing Sciences
journal homepage: http://www.elsevier.com/journals/international-journal-of-
nursing-sciences/2352-0132
Special Issue: Development and Inheritance
Speeding up development of the nursing profession and promoting
human health in China
Yan-Hong Guo
Deputy Director
General Bureau of Medical Administration,
National Health and Family Planning Com-
mission of the PRC, China
Health is an inevitable requirement for the development of all
human populations, as it underlies and impacts even the most basic
conditions related to economic and social factors. Health is an
important symbol of national prosperity and represents a personal
concern of every member among a nation’s overall populous, from
young to old and rich to poor. A key component of any health care
system is the nursing community, which plays an irreplaceable role
in maintaining and promoting the people's health.
In the Fifth Plenary Session of the 18th CPC Central Committee,
the goal of promoting the construction of a healthy China was put
forward. This goal was detailed as objective efforts to provide fair,
continuous and systematic health services for the people based
on two focus points: the whole population and the whole life cycle.
Professional nursing services play important roles in the whole pro-
cess of human life, with contributions in prevention of disease,
assistance in diagnosis and treatment, reducing pain and suffering,
and promoting rehabilitation. Therefore, to achieve the goal of a
healthy China, development of the nursing profession itself must
be accelerated, with care to progress the connotation and extension
of nursing so that it effectively addresses and meets the people's
health needs while being readily adaptable to further reform that
will support continual improvement of health care.
1. Remarkable achievements towards development of the
nursing profession in China
The CPC and Chinese government attaches great importance to
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the construction of an effective nursing team, critical for achieving
remarkable advances in health care development. Their collective
efforts have included a series of measures, such as the promulga-
tion and implementation of the development of careers in nursing
through the 11th Five-Year Plan and the 12th Five-Year Plan, the
implementation of Nursing Regulations, the augmentation of
training for nurses, the reformation of the clinical nursing mode
and strengthening of scientific management, as well as general ef-
forts to promote nurses’ performance of high-quality care.
1.1. Substantial increase in the number of nurses
By the end of 2015, the total number of registered nurses in
China had reached 3.241 million, representing increases of 1.9
million since 2005 and 1.2 million more since 2010. The trajectory
of increase in number of nurses resulting from the 11th Five-Year
Plan and the 12th Five-Year Plan is the fastest that China has ever
seen. Specifically, the number of nurses per 1000 people increased
from 1.06 in 2005 to 2.36 in 2015. The physician-to-nurse ratio also
improved from 1:0.97 in 2005 to 1:1.42 in 2015, resulting in a
fundamental reversal of the inverted physician-to-nurse ratio.
1.2. Continuous improvement of the comprehensive quality of the
nursing team
In 2015, 62.5% of registered nurses had a college (bachelor’s) de-
gree or above, and among these 14.6% had a bachelor’s degree. This
shift in higher education level, from secondary school to college or
above, highlights the improvement in the overall quality of nurses.
In accordance with the Five-Year Plan requirements, starting in
2005, China’s provinces (autonomous regions and municipalities)
initiated standardized training for specialist nurses in the intensive
care unit (ICU), emergency treatment, blood purification, tumor
care and organ transplantation. These ongoing efforts continue to
enhance nurses’ professional ability and technical skills.
1.3. Development of the concept of nursing, the work mode of
nursing and the connotation of nursing
The modern medical model and new health concept have a pro-
found impact on the practice of nursing, ultimately enriching the
connotation of nursing work. In 2010, the concept of patient-
centered holistic nursing care was pursued as a key objective, with
the primary aims of ensuring patient safety and treatment efficacy
6 Special Issue: Development and Inheritance / International Journal of Nursing Sciences 4 (2017) 5e7
so that clinical nurses can meet the health needs of their patients.
Realization of this key objective has involved implementation of
high-quality nursing skills, acceptance of the clinical nursing reform
mode, understanding and dedication to a responsible nursing system,
gaining of substantive attitudes towards care for patients, practicing of
professional observation and treatment approaches, recognizing the
psychological aspects of nursing (related to both the nurse practi-
tioners and patients under their care) and improving health educa-
tion. These collective efforts have already begun to achieve
improvements in nurses’ abilities to provide full, comprehensive
and professional services to patients in the health care setting.
Changing the core of nursing from functional care into holistic,
humanistic care will involve modification and edification on
many more subtle features that are, at first glance, distant from
the daily practice of nursing, such as income from the health
department, availability of medicines, and the performance-based
salary distribution system. However, there is an undeniable linkage
between the affects related to changes in the number of nurses, in-
come, nursing service quality, nursing career fulfillment and pa-
tient satisfaction. It is, thus, critical in the upcoming years that
development of nursing involve identity management, creation of
approaches to support and encourage dedication to the work, and
generation of a merit pay scale to promote excellence while
respecting equal pay for equal work.
It is paramount that an effective incentive mechanism be estab-
lished, one that will fully mobilize the enthusiasm and creativity of
nurses in the workplace. Implementation of such a mechanism will,
in turn, promote greater quality care and significantly increase the
satisfaction of patients and improve the degree of fulfillment that
the nurses obtain through their work. Meanwhile, improvements
in the edification and application of medical science and technol-
ogy for diagnosis and treatment services performed by nurses
will improve the technical level of clinical nursing professionals
overall, ultimately improving their abilities to treat critically ill pa-
tients and cases with more complex and challenging features.
1.4. Continuous development and expansion of nursing services
In order to meet the health needs of China, nursing care services
need to extend from the patient to the family and their community.
The services themselves need to expand to encompass the range
from disease prevention to treatment, including services to manage
chronic disease and the elderly patient population, as well as pro-
vision of long-term care, rehabilitation care and hospice care. In
this way, nurses will provide a wide variety of health care services
to benefit the entire population of China.
1.5. Continuous improvements in nursing scientific management
Across the country, China has more than 100,000 hospital
nursing management staff, who serve to strengthen the overall
management of the hospital and its nurses in particular. These staff
aim to improve the hospital’s organization, security and standards
of care. Innovation is the key feature of all of these efforts. Starting
from the focused point of nursing management, they develop new
mechanisms to improve the overall clinical practice and health care
operation of the hospital. The efforts thus far have included human
resource scientific management, scientific performance appraisal
and salary distribution, and have achieved positive results.
2. Opportunities and challenges for effective development of
the nursing profession
In his August 2016 presentation at the National Health Confer-
ence, President Xi Jinping stressed that without universal health
there is no comprehensive well-off society. He emphasized the
importance that we must put on human health, making it a na-
tional priority to develop a strategic position that will ultimately
promote healthy living, optimize the nation’s health services,
improve the construction of a healthy environment, and promote
development of the health care industry so as to ensure accom-
plishment of all-round, full cycle health for all of the nation’s peo-
ples. As China’s economy continues to develop and the Chinese
standard of living continues to improve, the related factors that
may influence human health and health services need to be identi-
fied and included in the overall efforts to achieve the universal
health that President Xi Jinping spoke of.
2.1. Rapid development of a medical system that meets the medical
needs of China today
In 2015, efforts began to improve the basic medical insurances
available for urban workers and residents, and the rural-
cooperative medical service was initiated. These efforts are ongoing
and will gradually encompass all urban and rural residents; to date,
however, the level of protection of urban and rural residents has
improved steadily, with reductions in the burden of medical ex-
penses already realized. It is critical to continue these efforts as
the demand for medical care will only continue to increase. Mean-
while, as the unceasing enhancement of China's economic and so-
cial development has allowed for the basic material needs of its
people to be meet, they are able to now pay more attention to
health and a collective desire to further improve quality of life
has arisen. Thus, there are greater requirements placed on the
health care system and its practitioners to develop and implement
diversified and multi-level mechanisms for providing high-quality
medical services.
2.2. Increasing burden of disease accompanying the
industrialization and urbanization of China, and the accelerating
aging population
At the end of 2015, Chinese nationals of ages 60 and above
accounted for 14% of the total population, representing approxi-
mately 222 million individuals. China's aging population is
increasing rapidly, and shows an uneven regional development,
with urban and rural populations affected differently. Moreover,
nearly 150 million of the elderly population suffer from chronic dis-
eases and nearly 40 million suffer from some form of disability. The
current and upcoming surge in demand for elderly care will require
significant adjustments to the medical and health care systems,
ensuring enhanced service capacity with focused service mode.
First, though, the connotation and skills of nursing service must
be modified to be able to meet this particular need. These modifi-
cations will involve several and various aspects of the nursing pro-
fession, ranging from those related to the medical center in which
nurses work to the services applied to the patients for disease pre-
vention, treatment and rehabilitation.
Public health-related fields are also shouldering a large portion
of the health care responsibilities towards the elderly population,
and play an irreplaceable role in the continuously improvements
of China’s medical service system as a whole. Efforts to further
strengthen nurses should not only engage clinical nursing work
carried out in hospitals, but also that carried out in the community
at large. Such grassroots efforts, from the hospital to the commu-
nity, will improve health care along all lines, from preventive ap-
proaches that target large social groups down to individual
families. This approach will remain crucial as long as there are peo-
ple in need of health care, and it should be reflected in the nursing
work that impacts these people.
 Special Issue: Development and Inheritance / International Journal of Nursing Sciences 4 (2017) 5e7
2.3. Influences of change in disease spectrum
Infectious diseases, HIV/AIDS, tuberculosis, hepatitis and other
diseases represent current threats to Chinese health. Newly
emerging infectious diseases are also arising within China, all while
the historically common infectious diseases, such as bacterial dys-
entery and measles, are continuing to pose great challenges to
our health care system. In addition, there has been a great rise in
chronic non-infectious diseases, such as cardiovascular disease,
cancer, diabetes and chronic obstructive pulmonary disease. These
challenges all impart increased burdens on China’s populations,
notwithstanding through increased medical expenses.
2.4. Challenges facing the medical service system in China
Unfortunately, there exists and unequal allocation of the exist-
ing medical service resources throughout China. There is an exces-
sive concentration of resources in city hospitals, and shortages
(accompanied by slow development) in community primary health
care centers. the majority of demand on medical and social re-
sources has been increasingly inclined towards the large hospitals,
while the primary health care institutions remain limited in their
facility conditions and technical level, even though they are prox-
imal and convenient for the local community. Although the overall
population of nurses has grown rapidly over recent years, only
600,000 of all nursing staff work at the grassroots level, accounting
for less than 20% of the total. Meanwhile, the existing medical ser-
vice system mode remains relatively simple and the public health
service demand is not consistent with the current diversification
spectrum.
3. Development goals and priorities
To further accelerate development of the nursing profession it is
of equal importance to build a healthy China, promote the overall
national health and well-being, instigate effective economic
restructuring, expand social employment and accelerate the devel-
opment of health services customized to the particular needs of the
proximal communities. To promote the development of health and
health reform, and meet the goals set forth in the “China 2030
Plan”, the nursing profession must be carefully developed with
respect to people's health at its core, so that the reforms and inno-
vative approaches generated will be oriented to the needs of each
community. The strategic deployment of a healthy China will ulti-
mately meet the health needs of people for their whole life cycle,
adopting and adapting the most progressive medical technology
that best supports the clinical services necessary.
3.1. Further strengthening the construction of effective nursing
teams
To support effective implementation of new “nursing regula-
tions”, adequate human resources, remuneration and occupation
safety programs must be in place. These features will safeguard
the legitimate rights and interests of nurses. Ultimately, such a
comprehensive approach to nursing staffing will help to further in-
crease the amount of registered nurses and nurses with specialized
skills, which is necessary in order to meet the current and up-
coming demands of clinical work. Other aims in this regard are
continuous improvements in defining the stratifications for nurse
level management, in establishing clear developmental paths for
the nursing occupation, generating fair and comprehensive nurse
grading systems, providing sufficient and convenient training for
professional and technical aspects of nursing, instilling dedication
to job responsibility, defining professional rank and salary
7
distribution, implementing management mechanisms to stabilize
the nursing team as a whole, and broadening the developmental
space for the nursing occupation.
3.2. Making efforts to improve the quality of nursing service and
expand the field of nursing services
Achievement of high-quality nursing service should be met
with the current objective of creating a nursing field that is
centered around holistic care. When the patient is at the center
of nursing care, nurses will strive to provide professional care,
meaningful patient observation, substantive health guidance, and
effective rehabilitation, psychological support and other skilled
services e all of which are the underpinnings of humanistic care
of patients. However, while developing this type of nursing, it is
key to also strengthen the quality of nursing with scientific man-
agement, so as to improve the efficacy and safety of the practices
applied. Increased access to high-quality training and education
programs and incentive policies and measures is also imperative
to improving the level of nursing skills in both urban and rural
medical centers.
We must also encourage the development of at-home nurses
and grassroots medical initiatives and facilities. These will help in
our efforts to expand the field of nursing services as needed in
the modern day, specifically as related to nursing care for the
elderly, and will gradually establish a mechanism for medical sup-
port within rural communities, which are more likely to rely on a
home-based elderly care service system. The integration of
comprehensive health care services for the elderly e during periods
of treatment, rehabilitation, stable health/general aging, and hos-
pice care e will also be supported by this approach.
3.3. Towards strengthening of nursing management
Scientific management of nurses implements measures that pro-
mote people-oriented strategies in nursing care. In this manner, the
patient is at the center of the service and the aim becomes to provide
safe, high-quality, standardized, continuous and personalized pro-
fessional services; this is in contrast to the traditional approach, in
which the clinical nurses are at the center, which has the benefit of
focusing on human resources, occupational safety protection, job
training, remuneration and promotion. The benefits of the latter
must not be lost during the shift to a patient-focused approach to
care. The new development of nursing in China, ultimately, must fully
encourage the enthusiasm of nurses and stimulate their initiative.
3.4. Towards further strengthening of nursing education in
according with clinical development
The need exists to establish nursing personnel training pro-
grams that are in line with industry needs and based upon a core
of skilled competency. Such programs will encompass college-
level education and graduate education, and provide access to sup-
plemental training outside of the formalized education. Such edu-
cation will not only aid in the desired transformation of nursing
research to clinical nursing practice but will also provide empirical
and technical support for the improvement of clinical nursing.
The development of Chinese nursing goes hand-in-hand with
the construction of a healthy China. The development speed must
match that of China’s society and economy, exploiting the most
recent advances in medical science and respecting the particular
health needs of the people in various communities across the
nation. In this way, nursing professionals will be able to improve
human health in our nation for the full range of the life cycle.